Multivariate analysis of intentional temporary vessel occlusion in aneurysmal surgery

: Temporary vessel occlusion (TO) for aneurysmal clipping is an effective technique to facilitate dissection between aneurysm and parent vessels, and to place a permanent clip at the aneurysmal neck precisely. However, several unsolved problems remain regarding the overall safety and risk resulting from this technique. The authors examined a series of patients in whom mannitol 500 ml, tocopherol acetate 500 mg, and phenytoin 500 mg were administered intravenously as ischemic protection during TO for the aneurysmal clipping. The study comprises a nonconcurrent retrospective analysis of 144 consecutive aneurysm clippings performed with the aid of intentional TO at the Hiroshima Prefectural Hospital from 1985 to 1995. To identify technical and patient-specific risk factors for perioperative stroke, factors studied included duration, location of the temporary clip application, number of occlusive episodes, patient sex, age, and preoperative neurological status, timing of operation, as well as postoperative, temporary or permanent, neurological deficits (ND) due to TO were used. Overall frequency of postoperative ND due to TO manifested clinically and radiologically were 9.0% and 9.7%, respectively. In both univariate and multivariate analysis there were no significant factors relevant to the ND. However, duration of the temporary occlusion time over 20 minutes was the factor most influential on the ND due to TO. Duration of the temporary occlusion time was shown to have no link with outcome. Based on our findings the authors conclude that temporary vessel occlusion within 20 minutes with anti-ischemic drugs is a relatively safe adjunct to aneurysmal surgery.